Volunteer Form

About you


Name (Inc. Title):

Address:

Postcode:

Tel:

Mobile:

Email:

D.O.B:

I am a UK resident:

National Insurance Number:

I have a full driving licence:

Where did you hear about volunteering with Jigsaw?

Which role(s) appeals to you?
BefriendingMentoringFundraisingEvents volunteerOther

If other, please specify:


Availability

Please tick the days that you would be able to volunteer:

MondayTuesdayWednesdayThursday
FridaySaturdaySunday

Please give us any additional information we might need to know about your availability:


Your emergency contact

Please provide the details of someone we can contact in the unlikely event of an accident or illness whilst volunteering for Jigsaw.

Name:

Relationship to you:

Tel:

Mobile:


Access requirements/health conditions

If you have any particular requirements or health conditions (e.g. medication or allergies) that you think we should be aware of, please state:


Your reason for getting involved

Please tell us what you hope to gain from volunteering with us:

Boost confidenceWork experience/improve career prospectsLearn something new

Share my skillsMeet new peopleHelp othersHave fun

If other, please specify:

Please tell us about the skills, knowledge and expertise you can offer:


My References

Please provide details of two referees who are over 18. One should be someone you know in a professional capacity, whilst the other can be a neighbour, friend or colleague. If you get stuck, we can help you think about who might be suitable to provide a reference.

Reference 1

Name:

Relationship to you:

Known how long?

Address:

Post Code:

Telephone No:

Email Address:


Reference 2

Name:

Relationship to you:

Known how long?

Address:

Post Code:

Telephone No:

Email address:


Recruitment of Ex-Offenders

Many of Jigsaw Support Scheme's volunteering opportunities will involve direct contact with potentially vulnerable older people. As such, applications to volunteer are exempt from the Rehabilitation of Offenders Act 1974.

This means that potential volunteers are required to declare their entire criminal record, including cautions, reprimands, final warnings and criminal convictions categorised as ‘spent’ under the above legislation.

The information provided will be kept confidential. It will only be disclosed to specific Jigsaw Support Scheme staff if/when they are considering you for specific volunteering opportunities (where you may come into contact with potentially vulnerable adults).
Have you ever been convicted at a Court or Cautioned by the Police for any offence?

(select as appropriate)

YesNo

If yes please give details, including date(s) and nature of offence(s):

Do you consent to a Disclosure and Barring Service check? (new CRB):
YesNo

If you are unsure about how to complete any part of this form please contact us to discuss


If interviewed by Jigsaw or their representative, do you agree to your words or images being used for marketing purposes?:
YesNo

Data Protection

All details given will be stored in a safe and secure way and will be kept confidential under the Data Protection Act 1998.


Declaration

If I am appointed as a volunteer I understand that the work I shall be doing could involve me receiving confidential information. I agree not to divulge any information concerning any person outside Jigsaw, unless authorised to do so.

I agree to support the aims and objectives of Jigsaw, and confirm that the information given in this form is correct to the best of my knowledge.

By ticking this box you agree to all of the above

Date: